How to reduce your risk of lawsuits with cataract surgery

Chicago-All ophthalmologists performing cataract surgery will experience complications at some point. Risk management involves preventing complications, recognizing them when they occur, managing them appropriately, and referring patients in a timely fashion when necessary, said Richard L. Abbott, MD, at the annual meeting of the American Academy of Ophthalmology.

"Cataract surgeons must communicate effectively with their staff and patients and recognize that when any problem occurs, the support and time they give to patients is greatly appreciated," explained Dr. Abbott, who is on the board of directors, Ophthalmic Mutual Insurance Co. (OMIC). "Ignoring the situation is a signal of abandonment to the patient and often the impetus for patients to seek an attorney."

Meticulous documentation; remaining current with the latest technology as well as with policies, guidelines, and standards developed by medical specialty societies; and acknowledging one's own surgical limits are also essential components of reducing the frequency of potentially compensable events and the severity and impact of losses once they occur.

A review of the 2004 OMIC data shows that 32% of all closed claims were related to cataract surgery, although indemnity was paid in only 14% of the closed cataract cases. Of the total indemnity paid by OMIC in 2004, only 18.4% was for cataract cases, Dr. Abbott reported.

Based on analysis of OMIC claims and suits during the past 10 years, several factors were identified as the more common risk management issues for cataract surgeons. Improper patient selection emerged as one of the most important.

Preferred practice patterns

"Surgeons need to know and follow the indications for surgery as outlined in the AAO's Preferred Practice Pattern 'Cataract in the Adult Eye,' be reasonably sure the benefits of surgery outweigh the risks, determine that cataract is the cause of visual loss, and recognize and preoperatively deal with patients with unrealistic expectations," Dr. Abbott said.

Informed consent is another key component in cataract surgery malpractice cases. Dr. Abbott advised being careful to handle the informed consent in advance of surgery rather than on the day of surgery. Doing so allows patients ample opportunity to ask questions and have a satisfactory discussion of the risks, benefits, and alternatives.

"Communication is key," Dr. Abbott said. "Patients who do not understand what they have been told or feel the doctor has not communicated with them well before or after surgery may develop feelings of anger, abandonment, and confusion that can bring on a malpractice claim in the case of a less than desirable outcome."

In addition, elements of the examination and informed consent discussion need to be documented in the chart. In discussing the procedure, it is important to avoid minimizing its potential risks.

"Cataract surgery has become very fast and safe, but trivializing it is not to the benefit of ourselves or our patients," Dr. Abbott said.

Regarding specific events, IOL-related problems are one source of cataract surgery medicolegal issues, including selection of incorrect power, size, and IOL type.

"With the new multifocal, accommodating, and single-focus IOLs, make sure you are implanting the right type for the patient and have safeguards in the OR to avoid mistakes," Dr. Abbott said.

Other complications that lead to malpractice claims include vitreous loss, retained and dropped lens material, stripped Descemet's membrane and other corneal problems, and choroidal hemorrhage.